Aiming to deliver more of what matters
Authors: None The Lancet Planetary Health
Journal: The Lancet Planetary Health (2023)

It is sometimes hard not to get disheartened if you are concerned about planetary health. Our leaders have consistently failed to recognise the scale of the threat posed by climate change, and the transgression of other planetary boundaries. Public awareness and concern have grown significantly over the last 20 years and government commitments in some areas show promise, but so far this has been wholly insufficient in practice. This isn't just an unwillingness to recognise and prioritise human health and the environment, or even down to effective lobbying of vested interests seeking to preserve the status quo, although both are in operation. More fundamentally than this there seems to be a collective, institutional and systemic failure of imagination, a failure to understand our dependence on the wider world, a failure to recognise the staggering rate and extent of environmental damages and the inequalities in how people are affected, and a failure to recognise the social and economic drivers of these issues. Put simply, much decision making, from individuals to small businesses, to regional and national governments often prioritises the wrong things and habitually fails to directly consider our health or that of the environment. To address this we don't just need piecemeal legislation or more ethical consumers, although these have a place, but we need systems and institutions that routinely consider and strive to prioritise health and the environment. Calls for socio-political transformation abound in reports on biodiversity and climate change. This is a reflection of the size of the environmental challenges we face, but it's rare to hear about truly transformative actions. Rather a more incremental approach is common. It's very understandable that organisations want to start with cheap, easy to implement solutions (often referred to as low hanging fruit) that improve, for example, the carbon intensity of electricity generation by 15%, or reduce plastic packaging by 40%. Such improvements are clearly worthwhile and yet there are limits to what can be achieved with a marginal approach when more substantial changes are required. Implementing the types of changes needed to, for example, completely decarbonise energy generation requires a different approach, and this is often difficult to achieve when the economic context treats these changes as low priorities. In recognition of some of the limiting structural imperatives built into the economy The Council on the Economics of Health for All was formed in 2020 by WHO, with an explicit remit to rethink the economy from a health for all perspective. The council has just published its report Health for All: Transforming economies to deliver what matters. The chair Professor Mariana Mazzucato argues that “States can move from reactively fixing market failures to proactively and collaboratively shaping markets that prioritize human and planetary health”. The report sets out 13 recommendations grouped under four pillars: governing health innovation for the common good, adequately valuing and measuring human and planetary health, financing health, and creating dynamic public sector capacities to achieve health for all. Of these pillars adequately valuing and measuring human and planetary health is the most directly relevant here. The recommendations call for health and wellbeing, health workers and health systems to be treated as a long-term investment, not a short-term cost. The use of legal and financial commitments to enforce health as a human right. The restoration and protection of the environment. And the use of a range of metrics that track progress across core societal values, above and beyond GDP. Most of these integrate well with environmental imperatives. Under the pillar Strengthening public sector capacity the report emphasises “there is a need to recognize that Health for all is not just for health ministries but for all government agencies”. This recognition reflects a broad need for more integrated thinking and policymaking which reaches across traditional knowledge disciplines and sector boundaries. This remains a major institutional learning challenge. The Health for All report contains important insight on how economies might be altered to better serve people and the planet, and it adds to the voices critiquing dominant economic norms. Such recommendations have an intrinsically political aspect and some of them directly relate to long standing political arguments. Whether those in the halls of power are ready to consider such fundamental economic reforms remains to be seen but the importance of these considerations can hardly be overstated.